The face recurve concept: medical and surgical applications.

The application of the Face Recurve theory gives rise to new technical opportunities in the fields of both aesthetic medicine and aesthetic surgery to block the action of the age marker fascicules largely responsible for aging of the paramedian folds. With respect to aesthetic medicine, the combination of botulinum toxin and soft tissue fillers has proven effective. On the basis of the authors' theory, however, two new technical refinements become pertinent. First, the filler must be injected predominantly deep to the muscle to treat the skin depressions in a more natural manner, bringing restoration to the curve of the overlying muscle. Second, a very low number of botulinum toxin units (one-fourth to one unit) should be injected into specific muscles to diminish their resting tone without diminishing their maximal contraction strength. With respect to aesthetic surgery, the authors present new techniques for the treatment of early aging, specifically a combination of segmental muscular section, microliposuction, and retromuscular fat grafting, all of which can be performed readily with the patient under local anesthesia. For more advanced aging, surgery offers new treatment opportunities that include the concentric malar lift for correction of the midface region, with repositioning of suborbicularis oculi fat back onto the orbital rim from its descended eccentric displacement at the hands of repeated orbicularis oculi contractions. At the same time, specific muscles can be weakened and fat volume restored. Each area can be studied in a specific way and treated definitively. Currently, the skin does not need to be tensioned to a maximum during a face-lift for treatment of the irregular jaw line, the palpebromalar groove, and so forth. Skin tension can be moderated to remove only the true excess of skin. Facial contour is improved, whereas the specific glide is restored between muscles and their underlying fat.